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Comparing anticoagulation therapy alone versus anticoagulation plus single antiplatelet drug therapy after transcatheter aortic valve implantation in patients with an indication for anticoagulation: a systematic review and meta-analysis

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Abstract

Purpose

This meta-analysis compared the efficacy and safety of oral anticoagulation (OAC) therapy alone versus OAC plus single antiplatelet therapy (SAPT) in patients with an indication for chronic OAC (mostly due to atrial fibrillation) after transcatheter aortic valve implantation (TAVI).

Methods

A systematic literature search was performed in the PubMed, Embase, and Cochrane Library databases to identify relevant studies. Data was extracted from the eligible studies and outcomes expressed as relative risks (RRs) with 95% confidence intervals (CIs).

Results

Five studies comprising 1344 patients with an indication for chronic OAC and undergoing TAVI were included. Of the 1344 patients, 480 patients received OAC therapy alone and 864 patients received OAC plus SAPT. There were no significant differences between OAC alone versus OAC plus SAPT in all-cause mortality (RR = 1.05, 95% CI 0.84–1.30, p = 0.69) and ischemic stroke (RR = 0.95, 95% CI 0.95–1.61, p = 0.86). However, OAC alone was associated with significantly lower risks of all bleeding events (RR = 0.62, 95% CI 0.49–0.69, p < 0.0001) and major and/ life-threatening bleeding events (RR = 0.57, 95% CI 0.42–0.76, p = 0.0002) compared to OAC plus SAPT.

Conclusion

In patients with an indication for chronic anticoagulation, post-TAVI antithrombotic therapy with OAC alone compared to OAC plus SAPT may be not significantly different in reducing all-cause mortality and ischemic stroke, but has an important benefit in a significantly lower risk of all bleeding and major and/life-threatening bleeding events.

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Availability of data and materials

All data generated or analyzed during this study are included in the article.

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Acknowledgements

First, we would like to express our gratitude to Professor Fabrizio D’Ascenzo for providing us with valuable data when we performed this research. Additionally, we also thanks EditSprings (https://www.editsprings.com/) for the expert linguistic services provided.

Code availability

We performed statistical analysis in the present study with Review Manager version 5.3 (Cochrane Collaboration; Copenhagen, Denmark).

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Authors and Affiliations

  1. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China

    Yong Zhu, Maolin Chen, Hong Li, Huagang Zhu & Zening Jin

  2. Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Shuai Meng, Ruofei Jia, Jing Nan, Long Li & Zening Jin

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  1. Yong Zhu
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  2. Shuai Meng
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  3. Maolin Chen
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Contributions

ZNJ, HGZ, and HL were responsible for the study conception and design. YZ, SM, and MLC contributed to data extraction, assessment of study quality, analysis and interpretation of data, and draft manuscript. The comprehensive literature search was completed by JN. RFJ and LL revised the manuscript critically.

Corresponding author

Correspondence to Zening Jin.

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The present study is a systematic review and meta-analysis, therefore ethics approval is not required.

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Zhu, Y., Meng, S., Chen, M. et al. Comparing anticoagulation therapy alone versus anticoagulation plus single antiplatelet drug therapy after transcatheter aortic valve implantation in patients with an indication for anticoagulation: a systematic review and meta-analysis. Cardiovasc Drugs Ther 35, 995–1002 (2021). https://doi.org/10.1007/s10557-020-07081-y

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